With the average age of the population increasing, the number of people with chronic diseases is also increasing. There is a lack of healthcare staff that are able to manage patients with chronic diseases and costs of treatments are rising, which has stimulated interest in developing chronic disease management (CDM) programs to try and avoid costly hospital readmissions. One example of a CDM program is home telemonitoring of patients with heart failure.
Disease management programs can follow a ‘tiered’ approach, with each tier or level of service corresponding to a particular “intensity” of monitoring, clinical attention and/or intervention, with the tier or level allocated being selected based on the severity level of the disease and, perhaps, the personal preferences of the patient. Depending on the medical condition, the different tiers can comprise different amounts or doses of a particular medication, different types of medication, different hospital- or home-administered tests and/or different (or some) surgical interventions. Generally, the more ‘intense’ the tier of service in the disease management program, the higher the financial cost of providing that service. As a result, certain programs or tiers of service may only become cost-effective at a certain level of disease severity.
A system and method for performing a cost-utility analysis of pharmaceutical interventions has been previously described in US 2007/0179809 A1. In this system, a patient perceived value, a utility value, an objective value and clinical trial data for various pharmaceutical interventions is compared to derive a gain per dollar expended for each pharmaceutical intervention, so that the most effective pharmaceutical intervention for the money expended can be chosen.
For some chronic diseases, the severity level of the disease can be objectively quantified using a test pertaining to the chronic disease performed in a laboratory or by equipment the patient can have at home. For example, N-terminal prohormone brain natriuretic peptide (NTproBNP) levels are a quantitative measure of the acuity level in heart failure patients (“NTproBNP and the diagnosis of heart failure: a pooled analysis of three European epidemiological studies”, European Journal of Heart Failure, 6 (2004), 269-273 by McDonagh, T. A., Holmer, S., Raymond, I., Luchner, A., Hilderbrant, P. and Dargie, H. J.). The test for the NTproBNP level is generally performed in a laboratory or in a clinical setting to determine the prognosis for the patient.